Pediatric Major Depression

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What is major depression?

Major depression, also known as clinical depression or unipolar depression, is a mood disorder that goes beyond everyday ups and downs. It is a serious medical condition and an important health concern in the United States.

Depression can affect an adolescent's body, mood, and thoughts. It can disrupt eating, sleeping, or thinking patterns, and treatment is often necessary, and sometimes crucial, for recovery.

True depression is not the same as being unhappy or feeling blue,” nor is it a sign of personal weakness or a condition that can be willed or wished away. Adolescents with a depressive illness cannot merely pull themselves together and get better.

There are three primary types of depression:

Major depression (clinical depression)

Bipolar disorder (manic depression)

Dysthymic disorder (dysthymia)

Who is affected by major depression?

The National Institute of Mental Health, part of the National Institutes of Health, reports the following:

Research shows that depression onset is occurring earlier in life today than in the past

Early-onset depression often persists, recurs, and continues into adulthood

Depression in children or adolescents may predict more severe illness in adulthood

There is a higher incidence of depression in adolescents whose parents experience depression

What are the risk factors for major depression?

There are many risk factors for depression, but the most common include the following:

Family history of depression (especially if a parent experienced depression as a child or adolescent)

Excessive stress

Abuse or neglect

Trauma (physical and/or emotional

Other psychiatric disorders

Loss of a parent, caregiver, or other loved one

Cigarette smoking

Loss of a relationship (i.e., moving away, loss of boyfriend/girlfriend)

Other chronic illnesses (i.e., diabetes)

Other developmental, learning, or conduct disorders

What are the symptoms of major depression?

Every adolescent may experience symptoms differently. However, the major symptoms of major depression include:

Persistent feelings of sadness

Feeling hopeless or helpless

Having low self-esteem

Feeling inadequate

Excessive guilt

Feelings of wanting to die

Loss of interest in everyday or enjoyable activities

Difficulty with relationships

Sleep disturbances (i.e., insomnia, hypersomnia)

Changes in appetite or weight

Decreased energy

Difficulty concentrating

Decreased ability to make decisions

Suicidal thoughts or attempts

Frequent physical complaints (i.e., headache, stomach ache, fatigue)

Running away or threats of running away from home

Hypersensitivity to failure or rejection

Irritability, hostility, and aggression

A major depression diagnosis usually means an adolescent exhibits several of the symptoms during the same two-week period. Because the symptoms of major depression may resemble other problems or psychiatric conditions, a physician should always make the diagnosis.

How is major depression diagnosed?

Because depression often co-exists with other psychiatric disorders, such as substance abuse or anxiety disorders, seeking early diagnosis and treatment is crucial to the recovery of the adolescent.

A child psychiatrist or other mental health professional usually diagnoses major depression following a comprehensive psychiatric evaluation. An evaluation of the adolescent's family, when possible, in addition to information provided by teachers and care providers, may also be helpful in making a diagnosis.

What are the treatments for major depression?

Specific treatment for major depression will be determined by the adolescent's physician based on:

The adolescent's age, overall health, and medical history

Extent of the symptoms

The adolescent's tolerance for specific medications or therapies

Expectations for the course of the condition

Child or parent’s opinion or preference

Treatment should always be based on a comprehensive evaluation of the adolescent and family. In addition, parents always play a vital supportive role in any recovery. Treatment may include one, or more, of the following:

Antidepressant medications (this has shown to be very effective in the treatment of depression in children and teens, especially when combined with psychotherapy)

Why should depression be treated?

Many parents of children or adolescents with depression never seek the appropriate treatment for their adolescent, although research has shown that many symptoms can improve quickly with the right treatment. In addition, continued treatment may help prevent reoccurrence.

Without appropriate treatment, symptoms of depression can persist for weeks, months, or years. In addition to causing interpersonal and psychosocial problems, depression in children and adolescents is also associated with an increased risk for suicide.

The Risk of Suicide

Suicide is a medical emergency that requires immediate treatment. The risk of suicide rises, particularly among adolescent boys, when the depression is accompanied by other mental health disorders or substance abuse. For this reason, all depressive and suicidal symptoms should be taken very seriously, and parents or caregivers should seek treatment immediately.

Treating childhood psychological conditions requires a higher level of understanding and insight into the particular needs of young patients. Our child psychologists and other mental health professionals work exclusively with children and teens, and emphasize patient and family-focused care.